Uncommon Cancer Presentations: When Testicular Cancer Mimics Spinal Cord Issues

Malignant Spinal Cord Compression Syndrome (MSCCS) occurs when cancer, in this case, testicular cancer, spreads and presses on the spinal cord. MSCCS is a rare condition, affecting only a small percentage of cancer patients. In a subset of these patients, MSCCS is the first sign of cancer. Germ cell tumors (GCTs), like testicular cancer, are infrequent causes of MSCCS, but when they do occur, they require immediate attention. Prompt diagnosis and intervention are critical to prevent irreversible neurological damage. In the context of this article, MSCCS was the initial presentation, later revealed to be caused by testicular cancer, highlighting the importance of considering MSCCS as a potential indicator of underlying malignancy.

The young man presented with a range of symptoms that initially suggested spinal cord issues. He reported a four-month history of pain and swelling in his left testicle, followed by progressive edema in his lower limbs, dysesthesia, and paraparesis. He also experienced urinary incontinence. These symptoms, especially the neurological ones such as dysesthesia and paraparesis, prompted investigation. The diagnosis of testicular cancer was confirmed through imaging studies, including scrotal ultrasound, CT scans, and an MRI of the dorsal and lumbar spine. These revealed a lesion in the left testicle, bilateral supraclavicular adenopathies, multiple pulmonary nodules, and spinal cord compression, leading to the final diagnosis of clinical stage IIIC testicular cancer.

Considering atypical presentations, such as testicular cancer presenting as spinal cord compression, is vital for several reasons. Cancer can manifest in unusual ways, often delaying diagnosis and treatment if healthcare professionals are not vigilant. In this case, the unusual presentation of MSCCS was the first indication of an underlying malignancy. By recognizing this, healthcare providers can order the appropriate diagnostic tests, such as scrotal ultrasounds and further imaging, leading to earlier detection and treatment of the cancer. Early intervention is critical because it can significantly improve patient outcomes, potentially preventing irreversible neurological damage and improving the chances of successful treatment.

Both laboratory tests and imaging studies were crucial in diagnosing the young man's condition. Initial laboratory tests provided some clues, with elevated LDH and abnormal AFP and hCG levels hinting at a possible malignancy. However, it was the imaging studies, including the scrotal ultrasound and CT scans, that provided definitive evidence. The scrotal ultrasound revealed a lesion in the left testicle, which, combined with the CT scans showing bilateral supraclavicular adenopathies and multiple pulmonary nodules, suggested the spread of cancer. An MRI of the dorsal and lumbar spine confirmed the malignant spinal cord compression, demonstrating a large retroperitoneal conglomerate invading the spinal cord and metastatic infiltration in the vertebral bodies. These findings collectively led to the diagnosis of clinical stage IIIC testicular cancer.

The key takeaways from the case study emphasize the importance of a broad diagnostic approach, especially in younger men presenting with spinal cord compression symptoms. Healthcare professionals must maintain a high index of suspicion for underlying malignancies, including testicular cancer, when patients present with atypical symptoms. Timely and accurate diagnosis hinges on thorough physical examinations, including genital exams, and appropriate imaging studies. Early diagnosis and treatment are critical to improve patient outcomes and prevent the progression of the disease. The case underscores the need for vigilance and a comprehensive approach in evaluating patients with unusual cancer presentations, as early intervention significantly impacts prognosis and quality of life.